Healthcare Provider Details

I. General information

NPI: 1750852216
Provider Name (Legal Business Name): SHARON LERAY
Entity Type: Individual
Gender: Female
Sole Proprietor: Y

II. Dates (important events)

Enumeration Date: 12/10/2018
Last Update Date: 07/12/2023
Certification Date: 07/12/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

651 KIMMERIDGE DRIVE 651 KIMMERIDGE DRIVE
BATON ROUGE LA
70815-6928
US

IV. Provider business mailing address

651 KIMMERIDGE DRIVE 651 KIMMERIDGE DRIVE
BATON ROUGE LA
70815-6928
US

V. Phone/Fax

Practice location:
  • Phone: 225-963-8092
  • Fax:
Mailing address:
  • Phone: 225-963-8092
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code101YM0800X
TaxonomyMental Health Counselor
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code171M00000X
TaxonomyCase Manager/Care Coordinator
License Number
License Number StateNULL

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: